45D1011785 CLIA NUMBER - RENAL CENTER OF TYLER

Laboratory Demographics

CLIA Number: 45D1011785

Facility Name: RENAL CENTER OF TYLER

Facility Address:
510 SSW LOOP 323 SUITE 580
TYLER, TX
ZIP 75702
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Facility Phone Number: 903 596-0102

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1124043187

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1011785
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RENAL CENTER OF TYLER
Street	510 SSW LOOP 323 SUITE 580
City	TYLER
State	TX
ZIP	75702
Phone	903 596-0102
CertificateType	4
CertificateEffectiveDate	9/6/2022
CertificateExpirationDate	9/5/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024